Accuracy of Combined Molecular and Morphology-Based Triage for HPV-Positive Women in Routine Cervical Cancer Screening Services From Colombia

Murillo, Raúl; Gamboa, Óscar; Hernández, Gustavo; González, Mauricio; Olejua, Peter; Molano, Mónica; Wiesner, Carolina

doi:10.2139/ssrn.3807230

Cited by 4 publications

(9 citation statements)

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“…However, in our study, strategies involving partial genotyping for HPV16/18 or HPV16/18/45 (with/without reflex VIA) had suboptimal sensitivity for high‐grade cervical lesions (≤65%). In line with our findings, studies from Cameroon, 5,8,14 South Africa, 17 Colombia 7 and China 11,12 also found that partial genotyping strategies had sensitivities below 65%, although in some studies sensitivity increased to >70% when adding reflex VIA 5,6,8 . While most cervical cancers are caused by HPV16/18/45, 21 HPV types 31/33/35/52/58 account for a non‐negligible proportion of cancers, especially in Africa 21,22 .…”

Section: Discussionsupporting

confidence: 89%

“…Our finding of low sensitivity of VIA triage is in line with studies from Sub-Saharan Africa of women living with HIV 6,8,15 and the general population, 10 as well as studies from other LMICs. 7,9 VIA performs poorly in older women due to difficulties in visualizing the squamocolumnar junction, but even when we limited the analysis to women aged <49 years, the sensitivity of VIA triage was <40%. In our study, we used standard naked-eye VIA, which is subjective and prone to interobserver variation.…”

Section: Discussionmentioning

confidence: 97%

“…Several triage methods for HPV positive women have been evaluated in LMICs, including visual inspection with acetic acid (VIA), 5‐10 measuring HPV viral load 9,11‐13 and partial genotyping for HPV16/18 or HPV16/18/45 5‐8,11,12,14 . However, few studies have directly compared several HPV‐based screening strategies in Sub‐Saharan Africa 5,6,8,15 .…”

Section: Introductionmentioning

confidence: 99%

“…2 The 2021 WHO guidelines also take the link between human immunodeficiency virus (HIV) and HPV into account, 4 and recommend either "screen-andtreat" or "screen-triage-and-treat" for the general population of women, whereas in women living with HIV, "screen-triage-and-treat" is recommended to reduce the risk of overtreatment. 2 Several triage methods for HPV positive women have been evaluated in LMICs, including visual inspection with acetic acid (VIA), [5][6][7][8][9][10] measuring HPV viral load 9,[11][12][13] and partial genotyping for HPV16/18 or HPV16/18/45. [5][6][7][8]11,12,14 However, few studies have directly compared several HPV-based screening strategies in Sub-Saharan Africa.…”

mentioning

confidence: 99%

“…2 Several triage methods for HPV positive women have been evaluated in LMICs, including visual inspection with acetic acid (VIA), [5][6][7][8][9][10] measuring HPV viral load 9,[11][12][13] and partial genotyping for HPV16/18 or HPV16/18/45. [5][6][7][8]11,12,14 However, few studies have directly compared several HPV-based screening strategies in Sub-Saharan Africa. 5,6,8,15 Recently, extended genotyping for a broad range of hrHPV types has been proposed as triage method in high-income settings, 16 but limited evidence is available on the utility of extended HPV genotyping in LMICs.…”

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confidence: 99%

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Comparison of human papillomavirus‐based cervical cancer screening strategies in Tanzania among women with and without HIV

Kahesa

Thomsen

Linde

et al. 2022

Intl Journal of Cancer

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Cervical cancer is the most common female cancer in Eastern Africa, and the World Health Organization (WHO) recommends human papillomavirus (HPV)‐based screening as a key element to eliminate the disease. In this cross‐sectional study from Tanzania, we compared nine HPV‐based cervical cancer screening strategies, including HPV testing at standard cut‐off; HPV testing at increased viral load cut‐offs; HPV testing with partial/extended genotyping, and HPV testing with visual inspection with acetic acid (VIA). We pooled data collected during 2008 to 2009 and 2015 to 2017 from 6851 women aged 25 to 65. Cervical cytology samples were HPV tested with Hybrid Capture 2, and HPV positive samples were genotyped with INNO‐LiPA Extra II. Human immunodeficiency virus (HIV) testing and VIA were done according to local standards. We calculated sensitivity, specificity, positive and negative predictive value of screening strategies, with high‐grade cytological lesions as reference, separately for women with and without HIV. HPV testing at standard cut‐off (1.0 relative light units [RLU]) had highest sensitivity (HIV+: 97.8%; HIV−: 91.5%), but moderate specificity (HIV+: 68.1%; HIV−: 85.7%). Increasing the cut‐off for HPV positivity to higher viral loads (5.0/10.0 RLU) increased specificity (HIV+: 74.2%‐76.5%; HIV−: 89.5%‐91.2%), with modest sensitivity reductions (HIV+: 91.3%‐95.7%; HIV−: 83.5%‐87.8%). Limiting test positivity to HPV types 16/18/31/33/35/45/52/58 improved specificity while maintaining high sensitivity (HIV+: 90.2%; HIV−: 81.1%). Triage with VIA and/or partial genotyping for HPV16/18 or HPV16/18/45 had low sensitivities (≤65%). In conclusion, HPV testing alone, or HPV testing with extended genotyping or increased viral load cut‐offs, may improve cervical cancer screening in Sub‐Saharan Africa.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of human papillomavirus‐based cervical cancer screening strategies in Tanzania among women with and without HIV

Kahesa

Thomsen

Linde

et al. 2022

Intl Journal of Cancer

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Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen‐positive women: results from the ESTAMPA study

Baena

Mesher

Salgado

et al. 2022

Intl Journal of Cancer

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Abbreviations: AI, artificial intelligence; ASC-US, atypical squamous cells of undetermined significance; CI, confidence interval; CIN, cervical intraepithelial neoplasia; cNPV, complement of the negative predictive value; ESTAMPA, EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano (Spanish acronym); GP, general practitioner; HPV, human papillomavirus; HSIL, high-grade squamous intraepithelial lesion; IARC,

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Migration and cancer mortality among Colombian migrants in the USA: a death certification study

Vries,

Arroyave,

Chayo

et al. 2024

Saude soc.

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We aim to compare cancer mortality rates of USA Colombian migrants (USA Colombians) to Colombians in their country of origin (CO Colombians). Using Colombian national mortality data and data on cancer deaths among Colombians residing in the states of California, Florida, and New York (USA Colombians) for the period 2008-2012, we estimated sex-specific and age-standardized mortality rates (ASMR), expressed per 100,000 persons. For comparisons between the two populations before and after adjustment for educational level, negative binomial regression models were used to compute Mortality Rate Ratios (MRR). CO Colombians had higher cancer mortality rates compared with USA Colombians (male MRR 1.4 [95%CI: 1.2-1.5], female MRR 1.5 [95%CI: 1.3-1.7]). These differences persisted for most cancers even after adjustment for education. CO Colombians had significantly higher mortality from gastric (MRR 2.6 in males and 2.8 in females) and cervical cancer (MRR 5.0) compared with US Colombians. Educational inequalities in cancer mortality were more pronounced among CO Colombians than among USA Colombians. Lower cancer mortality observed among USA Colombians cannot be attributed to differences in education, an indicator of socio-economic status. Rather, it is likely due to better access to preventive and curative healthcare in the USA.

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Accuracy of Combined Molecular and Morphology-Based Triage for HPV-Positive Women in Routine Cervical Cancer Screening Services From Colombia

Cited by 4 publications

References 0 publications

Comparison of human papillomavirus‐based cervical cancer screening strategies in Tanzania among women with and without HIV

Comparison of human papillomavirus‐based cervical cancer screening strategies in Tanzania among women with and without HIV

Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen‐positive women: results from the ESTAMPA study

Migration and cancer mortality among Colombian migrants in the USA: a death certification study

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